The goal of the proposed development program is to prepare the applicant, Mary Beth Hamel, M.D., M.P.H., for a career as an independent investigator in geriatrics health services research focused on assessing the effectiveness, costs and patterns of use of expensive and invasive medical interventions for elderly patients. During the period of the award, the applicant will acquire training in cost-effectiveness analysis, advanced biostatistics and quality of life assessment through supervised research activities, coursework, and directed readings. In addition, she will obtain formal training in clinical geriatrics. This training will build on her primary care internal medicine training will build on her primary care internal medicine training and the research tools she acquired during her general medicine fellowship. Lisa Iezzoni, M.D., M.S., an internationally recognized leader in health services research and Jeanne Wei, M.D., Ph.D., the director of Harvard Medical School s Division on Aging and a leader in academic gerontology, will serve as her co-sponsors. They are committed to her training and to the success of her projects and will help her take full advantage of the substantial research and clinical resources available at Harvard s Medical School and School of Public Health. During the award period, the applicant proposes to conduct research projects with the following specific aims: 1. To determine how older age influences survival, quality adjusted survival, and functional outcomes from serious illness; 2. To determine how a patient's age influences physicians' decisions regarding the use of invasive and expensive therapies; 3. To evaluate the cost-effectiveness of selected major medical interventions for elderly patients and to determine how advanced age influences the cost-effectiveness of these treatments. The applicant will accomplish specific aims 1 and 2 by analyzing data from the Study to Understand Prognoses and Preferences for Outcomes and Risk of Treatments (SUPPORT, a multi-center prospective study of 9105 seriously ill hospitalized adults) and the Hospitalization Elderly Longitudinal Project (HELP - a study of 1266 hospitalized patients 80 and older). She will address the third specific aim by designing and carrying out cost-effectiveness analyses which will involve collecting primary data on outcomes from a costs of invasive therapies for patients 80 years of age and older. By the end of the award period the applicant will have the skills, experience, and research track record needed to become an independent investigator and leader in geriatrics health services research.